Ostomies & Care Dawn Klecka, MSN, MBA, RN Deb Losicki, MSN, RN FNP-BC 2014 Spell-Check Nora Vetto, MSN, BSN, RN

Student Learning Objectives Verbalize understanding of the anatomy and physiology of the gastrointestinal tract Verbalize the understanding of conditions that would result in the need for an artificial port (ostomy) Verbalize the understanding of the different sites of an ostomy Verbalize the understanding of the care for an ostomy Verbalize the understanding of precautions required related to diet, activity, and medications for a patient with an ostomy Consider the ethnic, age related, and sexual needs of a patient with an ostomy Student Learning Objectives

Ostomy An Ostomy is a surgical opening for elimination of intestinal contents. The Stoma - is the opening through the abdomen; it is created when the intestine is sutured to the skin. An ostomy allows the diseased or injured portion of bowel to rest and heal. Ostomies can be temporary or permanent. What is an ostomy & stoma

Types of Ostomies Colostomy– is an opening between the colon and the abdominal wall. Types of Ostomies

Ileostomy Ileostomy – is an opening from the ileum through the abdominal wall. Ileostomy

Categorized by Location and Type Ascending Colostomy Descending Colostomy Ileostomy Sigmoid Colostomy Transverse Colostomy (Double Barreled) Which ostomy will have the most formed stool? Why? Which ostomy will have formed stool?

Purposes of Ostomy Allow the bowel to rest after trauma (gun-shot wound, for example) Following Colectomy 2nd to CRC Tumor Resection Bowel can be anastomosed after healing Permanent Immediate anastomosis Ostomy Purposes

Problems & Interventions Constipation - increase fluids, warm prune juice, increase fiber, fruit, bran & whole grain. Diarrhea - encourage fluids, bland food, small amounts, avoid spicy, hot or cold foods & high fiber. Flatulence - avoid carbonated beverages, gum, drinking from a straw, cabbage, beans, cauliflower & onions. Problems & Interventions

Diet Post surgery—Clear liquids Advanced to low fiber diet Then regulate nutrition intake to meet individual needs Goal to maintain adequate nutrition and avoid blockage and pain flatus, diarrhea and constipation. Risk for deficient fluid volume Goal is to avoid obstruction causes: fibrous meats, corn, cabbage, celery, green peppers, peas, fruit skins, seeds, nuts dried fruits, and popcorn are examples

Care of Ostomy Site Ostomy Management Ostomy Management

Ostomy Management Maintain privacy Remember the psychological effects: body image disturbance & self-esteem disturbance Perform care between meals Fecal material is very irritating to the skin Assess stoma & surrounding skin each time you change or empty the appliance. Look at color, and for edema, and bleeding Patient c/o burning under skin barrier may be 2nd to skin breakdown Follow hospital protocol on who may care for new ostomy and remove and change old established devices. Place gauze over the stoma site to catch any drainage.

Characteristics of Stoma Cause Rose to brick-red Pale Blanching, dark red-purple Edema Viable stoma mucosa Anemia Inadequate blood supply Normal post op Trauma, obstruction, allergy, gastroenteritis Characteristics of stoma color

Characteristics of Stoma Cause Bleeding Small amount Moderate to LARGE amount Oozing from stoma, if touched, is normal Coagulation factor deficiency Lower GI bleed Stoma Characteristics -bleeding

Ostomy Management Observe skin for irritation. Skin should be cleaned & dried thoroughly. Apply skin barrier cream around stoma Odor control is essential to patients self-esteem! Appliance should be cleaned in the bathroom when they are 1/3 to 1/2 full Avoid mealtimes to clean appliance! Ostomy Care

Measuring The pouch must fit snugly to prevent leakage. Stoma measuring card. Measure to fit no more then 1/6 the opening.

Colostomy Irrigation Similar to an enema. Insert lubricated cone tip before irrigation, otherwise the fluid will run out. Routine irrigation controls the time of elimination When regular pattern is achieved, the wearing of a colostomy pouch may be unnecessary Colostomy Irrigation

Nursing Diagnoses Risk for deficient Fluid Volume Risk for impaired skin integrity Deficient Knowledge Disturbed body image United Ostomy Associations of America - Ostomy, Colostomy, Ileostomy, Urostomy, Continent Diversion Support Groups Nursing Dx

Look at ostomy supplies in skills lab… Questions? Look at ostomy supplies in skills lab… Questions?